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Condition/Disorder Synonyms

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  • Intermetatarsal disorder

  • Morton's metatarsalgia

  • Plantar nerve lesion

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ICD-9-CM-Code

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  • 355.6 Lesion of plantar nerve

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ICD-10-CM Codes

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  • G57.6 Lesion of plantar nerve

  • G57.60 Lesion of plantar nerve, unspecified lower limb

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Preferred Practice Pattern1

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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Key Features

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Description

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  • Painful condition that affects the ball of the foot

  • Growth of scar tissue from chronic irritation of compression

  • Most common area is between the 3rd and 4th toes, but also can be in between the 2nd and 3rd toes

  • Involves a thickening of the tissues (neuroma) around one of the intermetatarsal plantar nerves

  • Branches from the medial and lateral plantar nerves

  • May alter mechanics during the push-off phase of gait

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Essentials of Diagnosis

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  • Can be an independent diagnosis and not associated with a disease process

  • Characterized by numbness, burning, and pain

  • Sometimes relieved by removing shoes

  • No visible deformity

  • Higher risk for individuals with bunions and flat feet

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General Considerations

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  • Feeling like you are stepping on something like a pebble

  • A burning pain in the ball of the foot that radiates to the toes

  • Tingling or numbness in the toes

  • Titled a neuroma, but is not a tumor formation as “oma”

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Demographics

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  • Ladies wearing high heels

  • Rock climbers with repetitive forefoot pressure

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Clinical Findings

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Signs and Symptoms

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  • Burning pain in the ball of the foot

  • Numbness and tingling in the toes, especially between the 3rd and 4th toes

  • Difficulty wearing/finding shoes, especially pointy ones

  • Limited motion of the MTP joint

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Functional Implications

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  • Pain with standing

  • Pain with ambulation at the toe

  • Inability to wear regular shoes

  • Need to wear larger shoes with a larger toe box

  • Alteration of gait pattern and mechanical issues of the forefoot

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Possible Contributing Causes

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  • Poor footwear: improper fit

    • Toe comes to a point (boots)

    • Narrow forefoot (high heels)

  • Certain sports

    • Repetitive trauma from high-impact activities, such as jogging or running

    • Those requiring tight shoes, such as snow skiing or rock climbing

  • Foot deformities: bunions, hammer toes, flat feet, excessive flexibility

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Differential Diagnoses

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  • Metatarsalgia

  • Metatarsal stress fracture

  • Capsulitis

  • Synovitis

  • Stress fracture

  • Tendinitis

  • Degenerative arthritis

  • Bursitis

  • Lumbar radiculopathy

  • Freiburg's disease: osteochondritis of the metatarsal head

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray

  • Diagnostic ultrasound

  • MRI

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Diagnostic Procedures

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  • Mulder's Sign (Pinch Test)2: Lateral squeezing of the forefoot with one hand and the opposite ...

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